Organization
TIDEWATER DENTAL AND ASSOC INC
Active
Other names
David J Cooper Michael W Owens Hae Sook Kim
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE M MCCABE (FINANCIAL ADMIN)
(301) 862-3900
Entity
Organization
Contact information
Practice address
21534 GREAT MILLS RD, LEXINGTON PARK, MD 20653
(301) 862-3900
(301) 862-3779
Mailing address
21534 GREAT MILLS RD, LEXINGTON PARK, MD 20653
(301) 862-3900
(301) 862-3779
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
MD13051
MD
1223G0001X
General Practice Dentistry
MD13931
MD
1223G0001X
General Practice Dentistry
Primary
MD6466
MD
Other
Enumeration date
11/03/2006
Last updated
07/01/2008
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